The Ethics of Fetal Surgery

Abstract

Many thoughtful things have been said in this conference about the fetus as patient. I shall take them as prolegomena to my remarks, which are directed at the surgical treatment of the fetus in utero or extra uterum. At the present time, intervention for three serious threats to fetal life and well-being are considered feasible. The first is surgical relief of obstructive hydrocephalus secondary to stenosis of the aquaduct of Sylvius. In this procedure, a shunt is introduced into the ventricles of the brain of the fetus via a needle inserted into the uterus through the maternal abdomen, and cerebrospinal fluid is drawn into the amniotic fluid. The second procedure is correction of the blocked fetal urinary tract. This is done either by placing a catheter through the maternal abdomen into the fetal bladder or by removing the fetus partially from the uterus, decompressing the bladder, and creating a physical channel from the kidneys or the bladder into the amniotic fluid. This second procedure, which involves externalization of the fetus, has been done, to my knowledge, only twice. I was involved in both cases and was present at the second surgery. The third surgical treatment considered feasible is correction of congenital diaphragmatic hernia. This procedure has not yet been done.